A new kind of delusion?

A growing number of psychotic patients believe they are the stars of reality TV shows.

By
Tori DeAngelis

2009, Vol 40, No. 6

Print version: page 32

Two brothers with expertise in mental illness—Joel Gold, MD, a psychiatrist at New York University School of Medicine, and Ian Gold, PhD, a philosopher at McGill University who specializes in the study of delusion—have been making news for exploring what they consider a culturally based manifestation of psychotic thinking: the belief that one is the star of a reality TV show. Some people particularly identify with the protagonist in the 1998 film "The Truman Show," in which Truman Burbank, played by Jim Carrey, discovers his entire life has been fabricated by the media and he is the unwitting center of a reality TV show.

Critics say the phenomenon, which the brothers have dubbed the Truman Show delusion, may simply be "old wine in new bottles" since it has some of the same psychological features as other psychotic delusions. But the Gold brothers contend that there are unique aspects to this delusion, specifically its breadth and potential to draw in otherwise normal people.

"We're not stating that this is a new mental illness," says Joel Gold. "But we are suggesting that there's a significant impact of culture on psychosis."

The phenomenon first came to Joel Gold's attention around 2002, when five patients told him they felt as if they were stars in reality shows—three specifically reported feeling like the protagonist in "The Truman Show."

Gold first presented his observations at a 2006 academic lecture for NYU medical staff, and media attention soon followed. Since then, the brothers have gathered case studies from international sources, and about 60 people have e-mailed them describing their own Truman-like delusions or reporting of patients who fit the criteria. Adding more to the research is a 2008 British Journal of Psychiatry (Vol. 193, No. 2) report on the case of a pre-psychotic patient who said he felt like the hero in "The Truman Show." The article also alluded to other patients with similar feelings.

As for what's driving the trend, the brothers speculate that certain features of modern culture—warrantless wiretapping and video surveillance systems like the one in London, for example—may create a plausible backdrop for those with a tendency to suspect that others are watching them. In addition, widely accessible technology and media that foster the notion of instant fame or put one at the center of attention—reality TV shows and MySpace, for example—square with the Truman Show's basic premise and with psychotic patients' delusions of grandeur, Joel Gold says.

These cultural elements could even serve as a tipping point for psychologically vulnerable people, though only proper studies can illuminate this, Ian Gold emphasizes. The brothers also are intrigued by the fact that these cultural features may be influencing people with no diagnosable mental illness.

"It is striking that these modern technological shifts could turn a delusion whose content in the past might have seemed highly bizarre, into something that in certain circumscribed circumstances might not seem as bizarre today," Joel Gold says.

Recently, the Golds also learned about an online chat room that is part of an online social networking site called "Orkut," visited by some 13,000 people who identify with the Truman Show hero. The brothers plan to investigate the site further to see who the visitors are and what they are discussing.

Meanwhile, other experts say the phenomenon is just a new version of an old psychosis.

"The idea of being under surveillance has been around for a long time," says David Downing, PsyD, a psychology professor at the University of Indianapolis. Downing wrote a 2007 article in Psychoanalytic Review (Vol. 94, No. 6) exploring how "The Truman Show," "The Matrix" and other films reflect modern anxieties about being subsumed by large, ominous and impersonal forces. In previous eras, he notes, psychotic delusions were fueled by current events as well—for instance, delusional people who during World War II or the Cold War believed that the Germans or Russians were spying on them.

The Gold brothers agree that culture has always played a part in psychosis. But they believe the Truman Show variation is unprecedented because it encompasses a person's entire mental world: Sufferers believe that all the people in their lives are actors, whereas past delusions have involved narrower sources of mistrust. With the "Capgras delusion," for instance, a person believes a loved one has been replaced by a double.

Whether or not you believe there's anything new about Truman-type delusions, research points to a need for mental health professionals to pay more attention to psychotic patients' culture and background, says Joel Gold, who treats these patients both with medication and supportive talk therapy.

"With psychotic patients, we tend to take the view that if they just take their medication, their symptoms will get better," says Gold. "But I think there's real meaning to the content of people's delusions."